State Medicaid Fees for Services Related to Opioid Use Disorder: Building the Evidence-Base to Inform State Policies

This contract is designed to support Urban Institute (UI) develop a state code crosswalk and build a database of the Medicaid fee schedule for approximately 25 key services related to evidence-based opioid use disorder (OUD) treatment across a variety of settings (e.g., outpatient, inpatient) for each of the 50 states. In addition, IBI will support UI in the creation of a Medicaid state fee index, as well as Medicaid-to-Medicare fee indexes, for each state to describe variation in Medicaid fees across states and relative to benchmarks. IBI will provide technical and analytical expertise on: • Development of a preliminary set of Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in claims data related to medication for opioid use disorder (MOUD), adjunctive therapies to MOUD, and other evidence-based services for OUD treatment across all levels of care as defined by ASAM. • The identification and analysis of Medicaid claims data to compare frequency of diagnosis codes for OUD, analyze FFS versus managed care reimbursement, bundling and incentive payments, and variation in reimbursement across Medicaid providers in Kentucky. • Validation of fee survey findings across multiple states. Conduct and share aggregate analysis with Kentucky Medicaid claims data to show utilization rates and reimbursement for the approximately 25 key services. • Provide consultation on development of national average expenditure weights and creation of the Medicaid fee index, review variation observed in the Medicaid state fee index, Medicaid-to-Medicare fee indexes.